Healthcare Chapter: Vital Signs

Study Notes

Vital signs are body temperature, pulse, respiration, and blood pressure.
Pain is now considered a fifth vital sign.
Vital signs assess the physiological functioning of the body. They include body temperature, pulse, respirations, blood pressure, pain, and pulse oximetry.

On admission to a healthcare agency to establish a baseline.
When a patient's health status changes or reports symptoms (e.g., chest pain, feeling hot).
Before and after surgery or invasive procedures.
Before or after medication administration that could affect the respiratory or cardiovascular systems.
Before and after any nursing intervention that might affect vital signs (e.g., ambulating a patient).

Body temperature is the balance between the heat produced by the body and the heat lost from the body.
It's measured in degrees.
Core temperature of deep tissues (thorax, abdomen, pelvis) remains relatively constant at 37°C (98.6°F).
Surface temperature of skin, subcutaneous tissue, and fat changes based on the environment.

Basal metabolic rate: The rate of energy use for essential activities (e.g., breathing). Metabolic rate decreases with age, with younger individuals having higher rates.
Muscle activity: Muscles produce heat through the breakdown of substances.
Fever: Increases cellular metabolic rate and body temperature.
Thyroid hormone output: Hormones like thyroxine and triiodothyronine increase basal metabolism by breaking down glucose.

Most heat is lost from the skin's surface through:
- Radiation: Emission of heat waves when body temperature is higher than the surroundings.
- Conduction: Direct heat transfer through contact with a cooler object.
- Convection: Heat loss via moving air currents (e.g., fans).
- Evaporation: Heat loss through the evaporation of water (e.g., sweating).

Age: Infants are susceptible to environmental temperature changes and need protection. Older adults (over 75) are at risk for hypothermia.
Diurnal variations: Body temperature fluctuates throughout the day, typically highest in the late afternoon/evening and lowest around early morning.
Exercise: Increases body temperature.
Hormones: Women typically experience more hormonal fluctuations than men; progesterone levels affect temperature around ovulation.
Stress: Increases the production of stress hormones that raise metabolic activity and body temperature.
Environment: Changes in environmental temperatures can impact a person's temperature regulation system.

Monitor vital signs.
Assess skin color and temperature.
Monitor white blood cell count and other lab results for infections or dehydration.
Remove excess blankets.
Provide adequate nutrition and fluids.
Measure intake and output.
Reduce physical activity.
Administer antipyretics as prescribed.
Provide oral hygiene.

Oral: Mouth. Contraindications: Infants/young children, unconscious/confused patients, recent facial/mouth/neck surgery/injury, oxygen use >6L/min, paralysis or seizure disorder
Axillary: Armpit. Indications: patients who mouth-breathe, have oral inflammation, or recent oral surgery, oral or rectal temperature not indicated.
Rectal: Rectum. Indications: Infants, young children, unconscious patients, mouth-breathing patients
Aural: Ear canal.
Temporal artery: Forehead.
Tympanic: Ear drum.